Routine inspection·December 16, 2025

On 12/16/2025 at 09:30 am Licensing Program Analyst (LPA) Lorena Casillas arrived at the facility for an unannounced one (1) year required visit. LPA was greeted and granted access by a staff member. LPA met with Licensee, Arlen Shahverdian. LPA informed Licensee of the purpose of the visit, entrance interview conducted. A fire clearance was approved on 8/20/2024, for four (4) non-ambulatory residents and two (2) ambulatory residents for a total capacity of six (6). The facility has four (4) bedrooms, three (3) of which are shared and for resident use. Currently the facility is occupied by six (6) residents. INFECTION CONTROL and EMERGENCY PREPAREDNESS PLAN: LPA reviewed facility Infection Control Plan and Emergency Preparedness Plan to make sure facility is following protocols. A tour of the physical plant was initiated at 10:30 am and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. There is an adequate supply of two (2) day perishable and seven (7) day nonperishable foods. LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Cleaning solutions are locked under the sink. Knives are kept locked in a kitchen cabinet inaccessible to residents. Continued on LIC809-C BEDROOMS: The facility has four (4) bedrooms, three (3) bedrooms are for resident use. Bedroom #1 and Bedroom #3 are designated for two (2) non ambulatory residents each. Bedroom #2 is designated for two (2) ambulatory residents. The applicant furnished the resident bedrooms with beds, nightstand, chairs, dresser, bedding and linens. All rooms had sufficient lighting. BATHROOMS: The facility has two (2) bathrooms. Bathrooms were observed to have the proper fixtures, trash cans with lids, paper towels, and non-skid mats. The hot water delivered in the bathrooms measured 116.9˚F. COMMON AREAS: These include the living room and dining room areas, which are equipped with living room furniture, a television, tables, and chairs. The dining room table is large enough to accommodate up to six (6) residents. There were no visible immediate hazards. The smoke alarms are functional, hard-wired and inter-connected. The carbon monoxide detector is functional. The facility has one fire extinguisher in the hallway that was purchased on 01/05/2025 and is fully charged. LAUNDRY ROOM: Laundry room is adjacent to the garage and has a functioning washer and dryer. Cleaning detergents and supplies are locked in the garage. MEDICATIONS: Medications and first aid kit are stored in a locked cabinet in the hallway closet. GARAGE: The garage is used for storage. There is a refrigerator used for extra food and water. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home were clear of obstruction. The backyard of the facility has a patio and backyard furniture. The facility backyard has sufficient yard space to accommodate outdoor activities. There are no bodies of water. STAFF AND RESIDENT FILES : LPA conducted a file review of staff records at 12:30 pm. No deficiencies cited. Exit Interview was conducted. Copy of report provided to Licensee.